human rights and legislation who resource book on mental health

Who can make an advance directive?
The Code of Health <strong>and</strong> Disability Services Consumers’ Rights gives any person <strong>who</strong> is legally
competent to make a health care choice the right to make an advance directive.
What can I make an advance directive about?
Advance directives should focus on treatment <strong>and</strong> care. For example, you could state:
· the treatments you do or don’t want to be given when you are in a crisis, including
drugs or ECT
· the places you would prefer to receive services when in crisis, such as hospital, home or
a crisis house.
Example:
An advance directive requesting a specific drug
Sally knows that when she starts to feel a certain way, it’s really important to begin treatment
with a low dose of drug X. During her first episodes of mental illness she became very unwell
<strong>and</strong> was hospitalised. Recently she shifted to a new city <strong>and</strong> is unsure whether her new doctor
really respects her own knowledge of her condition.
She decided to prepare an advance directive, which states that if she has another episode
she wishes to be prescribed drug X by her GP, rather than waiting for psychiatric referral.
While Sally’s request will be respected by her clinicians, the drug will be provided only if
clinically appropriate at the time.
How do I go about making an advance directive?
It’s not difficult to make an advance directive. You don’t need a lawyer. In fact, you have the
right to make an advance directive without involving anyone else in its preparation. However,
taking the following steps will help ensure that your advance directive is respected, <strong>and</strong> the
decisions contained within it acknowledged <strong>and</strong> acted upon.
· If possible, make your advance directive in writing rather than verbally. State your
preferences as clearly as you can, then sign <strong>and</strong> date it.
· If you prepare your advance directive with the help of your clinician or another health
worker, he or she can verify that you are competent <strong>and</strong> sufficiently informed about your
stated preferences, <strong>and</strong> can help you clarify the type of situation you intend your
directive to cover.
· If you involve your family or whanau in preparing your advance directive, or at least
inform them of it, they will be better equipped to support you <strong>and</strong> to advocate for your
wishes in a crisis.
· Regularly review <strong>and</strong> update your advance directive so that it reflects any changes in
your condition or your preferences, <strong>and</strong> is viewed by clinicians as still representing your
wishes.
· Keep a copy of your advance directive yourself, <strong>and</strong> give copies to your family or
support persons, <strong>and</strong> the clinicians most often involved in your care.
Will my advance directive always be followed?
No. When deciding whether or not to follow your advance directive, your clinician will consider
five questions:
· Were you competent to make the decision when you made the advance directive?
· Did you make the decision of your own free will?
· Were you sufficiently informed to make the decision?
· Did you intend your directive to apply to the present circumstances, which may be
different from those anticipated?
· Is the advance directive out of date?
The Code of Health <strong>and</strong> Disability Services Consumers’ Rights sets out your right to be fully
informed, make an informed choice, <strong>and</strong> give informed consent. However, your advance
directive will not override the ability of your clinician to authorise compulsory treatment if you
are subject to a compulsory treatment order under the Mental Health (Compulsory
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